Junior Doctor Contracts

I am a junior doctor who works as a fourth year specialty registrar in Ophthalmic Medicine at Addenbrooke’s Hospital. I am emailing about the new proposed government contract for junior doctors and the disastrous impact I fear it will have on retention of our young doctors.

I studied at Cambridge and am proud of being a part of the University, Hospital and City.

After graduating and working as a junior doctor, I spent a couple of years working in Auckland, New Zealand as I wanted to broaden my horizons. New Zealand had its own “junior doctor crisis” in 2009 as more than 40 percent of newly qualified graduates from the country’s two medical schools were moving to Australia, principally for better pay and training opportunities. Therefore the local District Health Boards were happy to be filling gaps with young British doctors. I found the process of moving and commencing training in Auckland quick and easy.

Although my intention was to stay in New Zealand for only a year (as a UK-accredited “Foundation 2 year”), my experience was so good in terms of the quality of training, quality of life, remuneration (my salary at an equivalent training level was double in New Zealand) and pastoral care that I stayed for two further years before returning home. However, I know of many junior doctors who have left to Australia, New Zealand and Canada and have remained in those countries.

The new contract seeks to extend the hours of the week which are considered to be within the “working week” for junior doctors. This is in marked disparity with other developed countries where the pay rate increases substantially for evenings and weekends due to the likely intensity of the job in those hours where clinical support is substantially reduced and in acknowledgement of the impact on quality of home and family life. Unfortunately, this proposal comes on top of many other large differences in training between the UK and other English-speaking developed countries:

– The lack of financial support given for the many training costs of junior doctors (registration fees, exams, courses)
– The reduced amount of protected time for teaching, research and management duties.
– The lack of support from management structures for the welfare of junior staff (for example in Australia and New Zealand if a junior doctor is unwell at short-notice, there is a “relief” junior doctor to cover that post and minimize clinical pressures)
– The lack of a strong union which annually re-negotiates contracts (As an example, the union in New Zealand successfully negotiated for junior doctors to have free meals a decade ago, which has significantly increased morale and retention despite the ongoing exodus to Australia)
– The already significantly lower pay of a British junior doctor in comparison with peers in other countries.

My fear with the new proposed government contract is that the number of junior doctors leaving for overseas will be increased to the extent that there will be large gaps in service provision throughout the country. In a hospital such as Addenbrooke’s, this would undoubtedly be disastrous.